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Kirtschig G, Kinberger M. [Genital lichen sclerosus and lichen planus]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:22-29. [PMID: 38133692 DOI: 10.1007/s00105-023-05267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Lichen sclerosus (LS) and lichen planus (LP) are chronic inflammatory dermatoses of unknown aetiology. They pose the most important differential diagnoses of inflammatory dermatoses in the genital area. There is often a delay in diagnosing LS and LP and subsequently treatment is initiated late in the course of the disease, which will lead to scarring and a decreased quality of life. There is an increased risk of the development of malignancies in the genital area in both diseases; however, early and continuous treatment with potent topical steroids will decrease this risk.
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Affiliation(s)
- Gudula Kirtschig
- Medbase Gesundheitszentrum, Unterer Graben 1, 8500, Frauenfeld, Schweiz.
| | - Maria Kinberger
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
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Reichert M, Aragona M, Soukkar A, Olianas R. Mesh Graft Urethroplasty—Still a Safe and Promising Technique in Mostly Unpromising Complex Urethral Strictures. J Clin Med 2022; 11:jcm11205989. [PMID: 36294313 PMCID: PMC9604618 DOI: 10.3390/jcm11205989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/28/2022] Open
Abstract
Long urethral strictures or even recurrent urethral strictures, mostly with scar tissue showing insufficient healing tendencies, are defined as complex and represent a big challenge in modern reconstructive urology. Initially, the treatment of complicated urethral strictures was associated with a high failure rate (20–40%) due to the growth of hair in the neourethra and a lack of sufficient suitable epithelium when scrotal skin was used. Although much effort was put into tissue engineering recently, harvesting and transplanting autologous tissue represent the standard of care for urethral substitution or augmentation. Since 1977, two-staged urethroplasty with the usage of free foreskin or 0.1 mm thick meshed skin from the upper leg was performed in complicated cases and was initially described in 1984 and 1989 by Schreiter and Schreiter and Noll, respectively. In stage 1, the graft is harvested by cutting the skin thinly above the hair follicles and transplanted as a plate around the opened urethra. In stage 2, after 8–12 weeks, the neourethra is formed. Success rates of up to 84% are described. Considering the complexity of the strictures in which mesh graft urethroplasty is usually performed, the reachable success rates are outstanding, especially considering that this surgery is most likely the last opportunity to prevent perineostomy or even urinary diversion. This article describes the surgical technique and embeds the mesh graft urethroplasty in today’s literature to underline its importance in the surgical management of complex urethral strictures.
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Affiliation(s)
- Mathias Reichert
- Department of Urology, Universitätsmedizin Göttingen, 37099 Göttingen, Germany
- Correspondence:
| | - Maurizio Aragona
- Department of Urology, Städtisches Klinikum Lüneburg, 21339 Lüneburg, Germany
| | - Ahmad Soukkar
- Department of Urology, Städtisches Klinikum Lüneburg, 21339 Lüneburg, Germany
| | - Roberto Olianas
- Department of Urology, Städtisches Klinikum Lüneburg, 21339 Lüneburg, Germany
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Abstract
Lichen sclerosus is a chronic, inflammatory dermatosis that usually affects the anogenital area. Early diagnosis and subsequent long-term anti-inflammatory treatment may reduce symptoms and signs and the risk of a mutilating course and the development of carcinomas.
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Affiliation(s)
- G Kirtschig
- Hautklinik, Universitätsklinikum Marburg & Gießen, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
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Aufderklamm S, Vaegler M, Kelp A, Maurer S, Gustafsson L, Mundhenk J, Busch S, Daum L, Stenzl A, Amend B, Sievert KD. Collagen cell carriers seeded with human urothelial cells for urethral reconstructive surgery: first results in a xenograft minipig model. World J Urol 2016; 35:1125-1132. [PMID: 27783146 DOI: 10.1007/s00345-016-1959-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/16/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Urethral strictures are a common disease of the lower urinary tract in men. At present, the use of buccal mucosa is the method of choice for long or recurrent strictures. However, autologous tissue-engineered grafts are still under investigation for reconstructive urological surgery. The aim of this pilot study was to evaluate the use of human urothelial cells (HUC) seeded on bovine collagen type I-based cell carriers (CCC) in an animal model and to evaluate short-term outcome of the surgical procedure. METHODS Four male Göttingen minipigs were used with immunosuppression (cyclosporine A) for this pilot xenograft study. HUC obtained from human benign ureteral tissue were stained by PKH26 and seeded on a collagen cell carrier (CCC). Seven weeks after urethral stricture induction and protective vesicostomy, cell-seeded CCC was implanted in the urethra with HUC luminal and antiluminal, respectively. After two weeks animals were euthanized, urethrography and histological assessment were performed. RESULTS Surgery was technically feasible in all minipigs. Stricture was radiologically established 7 weeks after induction. CCC was visible after two weeks and showed good integration without signs of inflammation or rejection. In the final urethrography, no remaining stricture could be detected. Near porcine urothelium, PKH26-positive areas were found even if partially detached from CCC. Although diminished, immunofluorescence with pankeratin, CK20, E-cadherin and ZO-1 showed intact urothelium in several areas on and nearby CCC. CONCLUSION Finally, this study demonstrates that the HUC-seeded CCC used as a xenograft in minipigs is technically feasible and shows promising results for further studies.
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Affiliation(s)
- Stefan Aufderklamm
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martin Vaegler
- Experimental and Clinical Research Center (ECRC), University Clinic Charité, Berlin, Germany
| | - Alexandra Kelp
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sabine Maurer
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Leon Gustafsson
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jens Mundhenk
- Department of Urology, Diakonie Hospital Stuttgart, Stuttgart, Germany
| | | | - Lisa Daum
- Animal Doctor Facility, Neustadt/Aisch, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Karl-Dietrich Sievert
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Mayr R, Pycha A. [Oral mucosa for reconstructive urethral surgery]. Urologe A 2013; 52:662-7. [PMID: 23657770 DOI: 10.1007/s00120-013-3118-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of oral mucosa for urethral stricture repair has become the standard approach in reconstructive urethral surgery. Compared to other tissues oral mucosa shows several advantages, such as simple harvesting, good urine tolerance and low harvesting morbidity. For defects of the male bulbar urethra measuring 2 cm or longer, urethral reconstruction with oral mucosa is the procedure of choice. The oral mucosa graft can be used as an inlay or as an onlay graft. Most repairs can be completed in one stage but for complex strictures two stages are needed.
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Affiliation(s)
- R Mayr
- Abteilung für Urologie, Zentralkrankenhaus Bozen, Lorenz Böhler Straße 5, I-39100 Bozen, Italien
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Hamza A, Behrendt W, Tietze S. Plastic end-to-end treatment of bulbar urethral stricture. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2013; 2:Doc13. [PMID: 26504704 PMCID: PMC4582493 DOI: 10.3205/iprs000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For bulbar urethral strictures up to 2.5 cm in length, the one-stage urethral plastic surgery with stricture excision and direct end-to-end anastomosis remains the best procedure to guarantee a high success rate. This retrospective review shows the results of 21 patients who underwent bulbar end-to-end anastomosis from 2010–2013. In 20 cases (95.3%) good results were archived. The criteria of success were identified by pre- and postoperative radiological diagnostics and uroflowmetry.
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Affiliation(s)
- Amir Hamza
- Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Wolf Behrendt
- Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Leipzig, Germany
| | - Stefan Tietze
- Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Leipzig, Germany
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